CREDIT CARD AUTHORIZATION FAX FORM

 

COWBOY CENTER

              Toll Free: 877-768-7312              

                  Tel: (305) 691-6605                    

                        Fax: (305) 691-4122                         

cowboycenter@bellsouth.net

www.cowboycenter.com 

ATT:

 

THIS AUTHORIZES  “COWBOY CENTER”

to charge to your account for the following order

CREDIT CARD (TARJETA CREDITO):

CARDHOLDERS NAME (NOMBRE):

CARD NUMBER (TARJETA #):    
EXPIRATION DATE (FECHA VENCIMIENTO)
CARDHOLDERS SIGNATURE (FIRMA)

                                                                                           

       BILLING ADDRESS

  

        SHIPPING ADDRESS    

     
     
     
     

CONTACT    INFORMATION

HOME: WORK FAX
CELL URL: EMAIL:

ORDER

QTY ITEM # DESCRIPTION SIZE COLOR PRICE
           
           
           
           
           

THANK YOU!